In response to the high cost of state-run Medicaid programs, the 1993 Medicaid estate recovery policy was established to enable states to recover assets from the estates of beneficiaries after death. Estate recovery may trigger behavioral responses from older adults who may no longer view real estate as an attractive asset, may borrow money from home equity to cover the cost of increasing care needs, or may avoid enrolling in Medicaid altogether. Using 1992-2008 data from the Health and Retirement Study, this study exploits the time variation in state adoption of estate recovery to determine the association of recovery policies with homeownership decisions, home equity, and Medicaid enrollment among low-income older adults using a difference-in-difference fixed-effects model. The implementation of estate recovery significantly decreased home equity in the overall sample and among Black and White subgroups as well as those over age 74years. Additionally, estate recovery implementation was associated with a significant decrease in Medicaid enrollment among unmarried, low-income individuals aged 65years and older. No significant association was found between homeownership and estate recovery overall or among subgroups. These findings suggest that those most at risk for Medicaid estate recovery, namely, low-income older adults, may behave exactly the way policymakers intended, avoiding enrollment in Medicaid and extracting housing wealth to cover the cost of their care. Still, it is worth reconsidering a policy that recoups less than 1% of the long-term services and supports budget from Medicaid estate recovery to the detriment of low-income families who already had few assets. These findings reflect the limited choices that older adults and their families have in making long-term care decisions, filling a gap in the extant literature, which has not adequately explored the impacts of estate recovery.

This study examined the frequency of screening-positive symptom levels for depression, anxiety, attention deficit hyperactivity disorder (ADHD), and internet use, as well as factors independently associated with these outcomes among university students. We aimed to clarify interrelationships among these conditions and various sociodemographic variables, using a large sample of 4,556 students. Participants completed a web-based survey, including a sociodemographic questionnaire, the Adult ADHD Self-Report Screening Scale for DSM-5, Beck Anxiety and Depression Inventories, and Internet Addiction Test. Based on established cut-off scores, the proportions of participants screening positive were 39.8% for depression, 37.7% for anxiety, 35.5% for ADHD, and 9.1% for elevated internet use symptoms. Furthermore, 6.2% of participants reported a history of suicide attempts. In multivariable logistic regression models, screening positive for depression was independently associated with younger age, not living with family, lower family income, a history of psychiatric disorders or suicide attempts, as well as co-occurring elevated symptom levels above the established cut-offs for anxiety, ADHD, and elevated internet use. Screening positive for anxiety was independently associated with female sex, a family history of domestic migration, being in a romantic relationship, and a history of psychiatric disorder or suicide attempt, as well as co-occurring elevated symptom levels above the established cut-offs for depression, ADHD, and elevated internet use symptoms. Screening positive for elevated internet use symptoms was independently associated with male sex, a family history of international migration, suicide attempt history, and co-occurring elevated symptom levels above the established cut-offs for depression, anxiety, and ADHD. These findings indicate a high burden of elevated symptoms in university students and underscore the urgent need for accessible mental health support systems, targeted screening, and referral pathways within universities.

ABSTRACT The ongoing debate over universal access to full-day kindergarten (FDK) persists in various states. Previous research lacks consensus on its effects, especially beyond the kindergarten year and among various student groups. Studying FDK within specific state contexts is beneficial because FDK experiences vary vastly across contexts. This study examines the impact of FDK in Utah using multiple years of student and school data. Research Findings: Our analysis reveals that FDK attendance is associated with enhanced literacy skills during kindergarten, especially benefiting students from marginalized backgrounds (e.g. Hispanic, African American, English Language Learners, and students from low-income families). However, the initial academic benefits of attending FDK were not sustained beyond the kindergarten year; by first and second grade, performance differences had largely disappeared, and by third grade even showed modest reversal effects. The favorable differential effects of FDK on students from marginalized backgrounds also largely faded out. Nevertheless, it is premature to dismiss FDK’s long-term benefits, as educational factors such as barriers and/or additional support and resources post-kindergarten are not considered in the current study. Practice or Policy: To sustain the benefits of FDK over time, continued support for FDK students beyond the kindergarten year may be essential.

The Role of Harsh Discipline in Early Childhood Trajectories of Anxiety and Depressive Symptoms.

Intestinal parasitic infections (IPIs) remain a major public health concern among school-aged children in developing countries. This cross-sectional study was conducted in Taiz City, Yemen, from November 2023 to April 2024, to determine the prevalence and associated risk factors of IPIs among 352 students attending both public and private schools. Stool samples were examined using direct wet mount (normal saline and iodine) and formalin-ether concentration techniques. Socio-demographic and hygiene-related data were collected through structured questionnaires and interviews. The overall prevalence of IPIs was 80.1%, with Entamoeba histolytica (72.7%) and Giardia lamblia (13.9%) being the most common parasites. Students in public schools showed significantly higher infection rates compared to those in private schools (P = 0.026). Furthermore, infection rates varied significantly by district, with higher prevalence in Salah district (P = 0.014), among low-income families (P = 0.019), and among children relying on relief water (P = 0.034). Data were analyzed using SPSS v22, with chi-square tests (P ≤ 0.05). Ethical approval was obtained from the National University's Ethics Committee, with informed consent from guardians. The findings reflect the persistent burden of IPIs in Yemeni children and underscore the need for improved sanitation, safe water access, and hygiene education in schools and communities.

One potential strategy to prevent unhealthy summer weight gain in children is to integrate obesity prevention interventions into the SUN Meals program, where free meals are offered to children from low-income households. The current study gathered insights from parents to (1) identify children's weight-related health behaviors that need support during the summer, (2) examine potential intervention activities and their relevant barriers and facilitators, and (3) describe the preferred logistics of a summer obesity prevention intervention. Two rounds of focus groups were conducted virtually between February and April 2025. Participants (n = 26) were parents of elementary school-aged children from low-income families. Data were analyzed using inductive thematic content analysis. The top five weight-related health behaviors parents identified as priorities for their children were (1) increasing fruit and vegetable intake, (2) getting sufficient sleep, (3) limiting screen time, (4) increasing physical activity, and (5) reducing added sugar intake. Most parents supported a weekly, half-day intervention at the SUN Meals program sites for elementary school-aged children. Activities deemed important included providing engaging nutrition education related to the food served; helping families establish bedtime routines and screen time agreements; and offering physical activities at the program sites. Parents also suggested low- or no-cost half-day programming on-site, complemented by take-home packets and additional follow-ups between sessions to reinforce intervention content at home. Parents supported the proposed structured summer obesity prevention intervention at SUN Meals program sites, noting its benefits for families' weight-related health behaviors and offering practical logistical suggestions.

Objective: To explore the association between family socioeconomic status (SES) and child neglect among preschool children in rural areas of Xi'an. Methods: A cross-sectional study was conducted. A total of 7 052 parents of children aged 3-6 years from kindergartens in 9 rural districts (counties) of Xi'an from March to April 2025, were investigated using a multistage cluster sampling method. The "Chinese rural norm evaluation scale for neglect assessment of children aged 3-6 years" was used to calculate scores across 6 dimensions and an overall neglect score to determine neglect status. A comprehensive SES score was constructed based on household income, parental occupation (the higher one), and parental educational level (the higher one). Logistic regression models were used to analyze the association of SES and its components with child neglect. The robustness of the results was verified using receiver operating characteristic (ROC) curves, restricted cubic spline (RCS) plots, subgroup analyses, and sensitivity analyses. Results: A total of 5 506 children were included, among whom 2 790 (50.7%) were boys and 2 716 (49.3%) were girls; 2 549 (46.3%) in senior class, 2 032 (36.9%) in middle class, and 925 (16.8%) in junior class. The overall prevalence of child neglect was 27.6% (1 519/5 506). The neglect rate of boys was higher than girls (30.8% (858/2 790) vs. 24.3% (661/2 716), χ²=28.35, P<0.001). After adjusting for all covariates, compared with the low SES group, the high SES group had a lower neglect risk in both boys (OR=0.44, 95%CI 0.34-0.56, P<0.001) and girls (OR=0.58, 95%CI 0.44-0.76, P<0.001). A significant linear dose-response relationship was observed between SES score and child neglect risk both in boys and girls (both P<0.001).When SES score alone predicted child neglect, the area under the curve (AUC) values (0.62 for boys, 0.61 for girls) were both higher than those of each individual SES component. Analysis of SES components showed that parental educational level had the strongest protective effect (high SES score group boys: OR=0.31, 95%CI 0.14-0.68, P=0.004; girls: OR=0.28, 95%CI 0.10-0.82, P=0.019). Subgroup analysis (most subgroups, P<0.05) and sensitivity analysis (E-values for high-score boys and girls were 4.01 and 2.87, 95%CI 2.94-5.35 and 1.97-4.00, respectively) comfirmed the robustness of the association. Conclusions: Family SES is negatively associated with child neglect in rural areas of Xi'an with a clear dose-response relationship. Parental educational level is a key protective factor in reducing child neglect risk. Comprehensive interventions targeting low-income and low-education families are recommended.

Obesity represents a significant public health challenge on a global scale, with its prevalence increasingly linked to socio-economic factors, most notably family income. This study investigates the relationship between family income and several obesity measures specifically, the Body Shape and Size Index (BSSI), Body Mass Index (BMI), Body Surface Area (BSA), Ponderal Index (PI), Weight/Body Mass (BM), and Height within a sample of 9,906 respondents from Pakistan. Utilizing descriptive statistics and p - values, the analysis aims to provide a comprehensive understanding of how variations in income affect these obesity indicators, ultimately informing potential public health interventions. The findings reveal a complex, variable association between family income levels and obesity measures that differs by the specific obesity index examined. For BSSI, individuals in the lowest income bracket demonstrated higher values (indicating greater adiposity), while for BMI and weight, higher income brackets showed elevated values. These mixed findings suggest that the direction of association depends critically on which obesity measure is analysed. The study reveals that lower-income families are more likely to face barriers in accessing nutritious food, engaging in physical activity, and achieving favourable health outcomes. This situation is often exacerbated by economic constraints that drive families toward caloric-dense, nutrient-poor food choices. The implications of this research are far-reaching, emphasizing the need for targeted public health strategies to address obesity, particularly among economically disadvantaged populations. The study advocates for policies that enhance food security, improve access to health-promoting resources, and create supportive environments for physical activity. Through a nuanced exploration of these relationships, the research aims to contribute valuable insights to the field of public health, promoting equity in health outcomes and addressing the root causes of obesity in Pakistan.

ABSTRACT Health is influenced significantly by poverty. Mothers living in poverty experience higher stress compared to mothers with more financial resources. Children who live in poverty also experience mental health concerns, including higher externalizing and internalizing mental health symptoms. Families’ support systems, or public and private safety nets, are central mechanisms for counteracting poverty’s negative impact; however, most research examines public and private safety nets separately. This study tested the extent to which public and private safety nets worked together to promote maternal and child wellbeing among a sample of mothers from the Future of Families and Child Wellbeing Study (N = 2,680). Using data from waves 1, 3, and 9, results showed significant interaction pathways between public and private safety nets to child outcomes through maternal stress. The identification of these pathways can be used to inform policies aimed at providing a more responsive, equitable safety net for low-income families.

The Interim Canada Dental Benefit (CDB) provided financial support for the dental needs of children < 12 years old, from low-income families in Canada. Funds were distributed during two periods, Regular Period 1 (October 2022 through June 2023) and the Regular Period 2 (July 2023 through June 2024). This study evaluated the adjusted rate of child participation across provinces and territories, proportionally for children aged 0-11 who lack dental insurance, from households with a net annual income < $90,000 (Canadian). Publicly available data were sourced from the Government of Canada Open Data Portal. Variables of interest were presented as distributions by provinces and territories, age grouping of children, and family net income. Child participation rates were calculated based on Statistics Canada data (2025). A total of 452,460 applications were accepted, with $440.7 million distributed. The adjusted national rate of participation for children without private and public dental insurance from low-income households was 267.3/1000 children in Regular Period 1 and 273.2/1000 in Regular Period 2. The provinces and territories with the highest adjusted rates were Nova Scotia, Saskatchewan, Newfoundland and Labrador, and the Northwest Territories. Families earning less than $30,000 annually made up the largest share of applicants. Government-funded programs, like the Interim CDB, have the capacity to improve access to dental care for Canadians. The results show clear regional differences, with higher participation often found in regions where public dental programs for children are limited or absent.

ABSTRACT This study evaluates child-friendliness at the neighborhood scale in Dhaka across two socio-spatially contrasting neighborhoods that represent planned and unplanned urban forms, using a multidimensional framework that integrates spatial and socio-perceptual indicators. While planned neighborhoods are commonly perceived as child-friendly, they often exclude middle-income families through privatized amenities. Conversely, unplanned neighborhoods, despite infrastructural deficits, offer inclusive access to amenities and foster stronger social ties, particularly benefiting lower-income families. Logistic regression analysis identifies proximity to amenities, daily recreational engagement, neighborhood safety, and social networks as key predictors of parental satisfaction with child-friendliness. These findings provide actionable insights for planners and policymakers to refine child-centered planning strategies.

This study examined the effects of Artificial Intelligence (AI) on the academic performance of Grade Six pupils in selected public elementary schools in the District of Binangonan, Division of Rizal, School Year 2025–2026. It employed a descriptive survey research design complemented by documentary analysis of pupils’ quarterly grades. A total of 352 respondents were selected from 2,042 Grade Six pupils using Slovin’s formula and simple random sampling. Data were gathered through a researcher-made questionnaire-checklist measuring AI’s perceived effects in terms of motivation, class engagement, lesson mastery, and critical thinking and problem solving. Academic performance was determined using first and second quarter grades. Findings revealed that most respondents were 12 years old, female, firstborn, and from low-income families. Parents were generally high school to college graduates, with varying occupations, and pupils reported occasional use of AI tools. Results indicated that AI has a high perceived effect on pupils’ motivation, engagement, lesson mastery, and critical thinking skills. No significant differences were found in the perceived effects when grouped according to age, sex, number of children in the family, father’s educational attainment, and monthly family income. However, sibling position, mother’s educational attainment, parents’ occupation, and frequency of AI use showed significant differences. Pupils demonstrated a Very Satisfactory level of academic performance. Moreover, no significant positive relationship was found between perceived AI effects and academic performance. The study concludes that AI meaningfully influences learning processes but does not directly translate to higher academic performance. It recommends the formulation of school policies on AI integration, teacher training on instructional alignment, parental guidance, and responsible pupil use of AI as a learning support tool. Future researchers are encouraged to explore additional variables and conduct longitudinal studies to further validate these findings across diverse learning contexts and improve AI integration practices in basic education in the Philippines.

Background: Rates of recommendation uptake following a neuropsychological evaluation are low, and are even lower for families living in socioeconomic disadvantage. To identify families most at risk, we explore rates and socioeconomic predictors of uptake in a sample of families receiving low/no-fee evaluations. Additionally, we characterize reported barriers to uptake. Methods: Participants included 2,126 children/families who completed both a neuropsychological evaluation in a hospital-based clinic and an annual Individualized Education Program (IEP) meeting following evaluation. Evaluation in this clinic includes free and optional educational advocacy support. Data regarding rates of and barriers to recommendation uptake were gathered using patient questionnaires and medical records. Predictors of recommendation uptake were investigated using multiple logistic regression analyses. Results: Following evaluation, 40% of families had all recommendations implemented and 54% had recommendations deemed essential by their clinician implemented. Families who spoke mostly Spanish at home were significantly less likely to have all recommendations implemented (OR = 2.22, B = 0.797, p = .005). Children who received more diagnoses after evaluation were significantly more likely to have all essential recommendations implemented (OR = 0.88, B = −0.131, p = .023). The two most commonly reported barriers to recommendation uptake were: (1) parents failing to follow up with clinic staff and (2) clinic-school disagreement regarding services needed. Conclusion: This study is one of the first to examine predictors of recommendation uptake among families living in socioeconomic disadvantage. Families facing language barriers were less likely to access services. Additionally, youth with fewer diagnoses and thus potentially less severe challenges were less likely to have recommendations implemented. Future research should test interventions, such as educational advocacy, to mitigate the impact of these risk factors.

BackgroundOral health in early childhood is vital for long-term well-being, yet dental caries is highly prevalent among young children in the United States, especially in low-income and immigrant families. Brazilian immigrants, a rapidly growing Latin American population in the United States, face distinct barriers to oral health care, such as language differences, limited access to care, and a lack of culturally tailored resources. Despite this, Brazilian immigrants are understudied in public health research. Understanding Brazilian immigrant parents’ perspectives is essential to advancing oral health equity through culturally responsive strategies.ObjectiveThis study aims to understand (1) parents’ views on the best ways to support their children’s oral health, (2) perceived barriers to oral health care, and (3) preferred methods and strategies for addressing barriers and receiving oral health education and care.MethodsThis qualitative study usedin-depth, semistructured interviews with Brazilian immigrant parents. Guided by the social ecological model, the data were thematically analyzed to identify multilevel influences on oral health behaviors as well as intervention preferences.ResultsForty-eight Brazilian immigrant parents (29 mothers and 19 fathers) participated. Most had low acculturation levels and lived in primarily Portuguese-speaking households. Parents stressed the need for early, community-based oral health education in schools and daycares. They preferred visual and digital materials, such as videos, apps, and cartoons in Portuguese to overcome language barriers. Parents spoke of language and cultural challenges, limiting access and reducing confidence in navigating care. Access to affordable dental services was a major concern. Parents supported expanded school-based services and culturally welcoming care. Notably, mothers often focused on home routines and navigating systems, while fathers emphasized community outreach and structural barriers.ConclusionsBrazilian immigrant parents called for linguistically and culturally tailored oral health programs to be offered in trusted community settings, along with improved dental care access through policy changes and expanded insurance coverage. Multilevel strategies addressing both behavioral and systemic barriers show promise in reducing disparities. Future efforts should prioritize the development and evaluation of scalable, culturally responsive models that meet the needs of Brazilian immigrant families.

The impact of the 2021 Child Tax Credit on perinatal health: Evidence from the Expansion and Post-expiration Periods.

Caregiver burnout in parents of children with neurogenic bladder: Prevalence and determinants.

We investigated School Dropout Intention (SDI) and the role that educational-context and psychological factors play in shaping it during compulsory education in a cohort of 247 students (57.5% male; Mₐ ge = 12.11, SDₐ ge = 1.92) officially recognized as living below the poverty threshold. Data were analyzed by means of latent growth as well as Autoregressive Latent Trajectory (ALT) models. Results showed a gradual increase in SDI across compulsory schooling, which predicted students' subsequent school absences; however, no acceleration emerged as they approached the legal dropout age. Teacher and parental autonomy support reduced SDI over time. Regarding peer relationships at school, victimization predicted higher SDI, whereas peer friendship showed no significant association. Among psychological variables, self-esteem emerged as a stronger protective factor than self-efficacy, and identified motivation was more effective than intrinsic motivation in counteracting the development of SDI. Overall, the findings highlight key contextual and individual processes shaping dropout intention among low-income students. • School Dropout Intention (SDI) increases steadily throughout compulsory education. • Initial levels and increases in SDI predict subsequent school absences. • Teacher and parental support for autonomy appears to be effective in lowering SDI. • Peer victimization predicts more SDI. • Identified motivation and self-esteem proved to counteract SDI.

Literature suggests that the COVID-19 pandemic may have disrupted children's executive functioning (EF) development, but most studies rely on caregiver reports, cross-sectional data, or comparisons across cohorts. We build on the existing literature with repeated, direct assessments of EF from longitudinal pre-post COVID-19 data on a race-ethnically diverse cohort of elementary-aged children (N = 667) from low-income families. Random-intercept models estimate children's growth in two key EF skills between the fall of kindergarten (2018) and fifth grade (2023) as a function of school closures. We also test for moderation in children's growth trajectories by teachers' reports of children's compliance with remote learning expectations. Results indicate that children's EF growth stagnated during school closures, resulting in an estimated 11-12 months of lost growth compared to prepandemic trends. Postreopening, EF growth continued but at a 65%-74% slower rate than preclosures. Children who completed insufficient remote work demonstrated less stagnation in their inhibitory control/attention growth, which may have been driven by selection. Changes otherwise did not vary according to children's level of participation in remote learning during school closures. Findings underscore the need for interventions to support children's recovery of EF growth, as well as more research on the roles of school closures versus other pandemic-related stressors in the observed patterns. (PsycInfo Database Record (c) 2026 APA, all rights reserved).

Street-view-measured greenspace components and childhood myopia: A population-based cross-sectional and prospective cohort study.

This paper presents the first empirical evidence linking tobacco tax policies to unintended social consequences in the form of increased energy poverty. We focus on Australia, where smokers face some of the world's highest cigarette prices. We analyse an unanticipated aggressive tax regime implemented in 2010 using a difference-in-differences approach with a nationally representative panel dataset covering 14 years. Our findings indicate significant increases in the incidence of energy poverty among smoking households. Relative to the smoking cohort's pre-policy mean, subjective reports of heating difficulties rose by 24%, while objective measures increased by 38% (10% energy-burden threshold), 15% (twice-median burden), and 26% under the Low-Income High Costs (LIHC) measure. Mechanism analyses indicate that reduced energy expenditures and compromised financial stability exacerbate the observed energy poverty. The impacts were particularly pronounced among lower-income families, heavy smokers, and individuals who find quitting hard. This research highlights the complex trade-offs involved in aggressive tobacco taxation and emphasises the need for targeted measures to mitigate the negative consequences on the energy well-being of vulnerable smokers and their families.